Pennsylvania Rental Application

Pennsylvania Rental Application
TO APPLICANT
This application must be completed in full. If None, so indicate. All items are subject to verification. A false or willfully omitted statement in this
application will be grounds for its rejection, or the cancellation of your lease at the option of Landlord.
This application must be accompanied by a fee of $
for processing and credit reports. This fee is not refundable.
Landlord
Phone No.
Property Address
Apt. No.
Date
1. APPLICANTS
Name
Social Security No.
Date of Birth
Occupation
Name
Home Phone
Business Phone
Marital Status
Drivers License No.
Pets (Special written permission required)
Childrens Names and Ages

Why are you moving?
Present Rent
Utilities
2. LAST THREE RESIDENCES

Present Address, City and State
Zip Code
Dates of Occupancy
Landlords Name, Address, Phone No.
Previous Address, City and State

Previous Address, City and State
3. EMPLOYMENT
Supervisors Name
Present Employer
Address and Phone No.
Zip Code
Dates of Employment
Address and Phone No.
Zip Code
Dates of Employment
Previous Employer
4. EMPLOYMENT OF SPOUSE
Supervisors Name
Present Employer
Previous Employer
5. LIST OF MOTOR VEHICLES

Make
Do You Desire Garage Rental?

Year
Yes
No
Color
Type
License No. and State
Previous Employer
6. LIST OF YOUR PROPERTY
7. MONTHLY INCOME
WHICH WILL BE LOCATED ON THE RENTAL PREMISES

Items
Furniture
Value
Sources
Amounts
TVs, Stereos, Radios, etc.
Total $
8. CURRENT LOANS AND OBLIGATIONS

Company or Person
Reason
Time Left
Monthly Amount
$
Total
9. FINANCIAL REFERENCES
Name
Address
Account No.
Bank
Savings:
Checking:
Charge Account
Charge Account
10. PERSONAL REFERENCES

Name
Relationship
Address
Phone
In Case of Emergency, Notify:
11. GENERAL
Have you received welfare assistance within the last two years? ............................................................................................................................... Yes No
Have you received unemployment compensation within the last two years? ............................................................................................................. Yes No
Are you eligible for any governmental housing subsidy? ........................................................................................................................................... Yes No
Have you ever been ejected for non-payment of rent or otherwise failed to meet your lease obligations? If Yes, explain in remarks. .................... Yes No
Have you ever been convicted or pleaded guilty or no contest to a felony (whether or not resulting in conviction)?
If Yes, explain in remarks. ...................................................................................................................................................................................... Yes No
Have you ever been convicted or pleaded guilty or no contest to a misdemeanor involving sexual misconduct (whether or not
Yes No
resulting in conviction)? If Yes, explain in remarks. ..................................................................................................................................
12. REMARKS
13. RENTAL INFORMATION
How Did You Hear About This Rental Unit?
Classified Newspaper Ad
Yellow Pages
Internet Listing
Web Site
Personally Recommended
Other
Saw Rental Unit While Driving By
I CERTIFY THAT the above information supplied is true and complete to the best of my knowledge. I authorize verification of all information given;
and understand that additional information will be obtained from the Apartment Association of Northwestern Pennsylvania, Inc., the Credit Bureau, and
other services. I understand that my rent payment record, my performance of rules and lease obligations, and my treatment of the premises will be
reported to credit reporting agencies and to other landlords.
I understand that this application may be accepted or rejected at the discretion of the landlord. I understand and agree that rents and deposits paid
toward the rental unit will be refunded only if this application is rejected by the landlord; and that otherwise, those rents and deposits will be applied as
specified in the lease agreement.
Date:
DISCLAIMER
Signatures:
Copyright 2000 by Apartment Association of Northwestern Pennsylvania, Inc. The use of this Application is exclusively reserved for Association
Members. The form and content of this Application may not be reproduced in whole or in part without written permission. All rights reserved. No
liability is assumed for its use.

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Pennsylvania Rental Application

for processing and credit reports. This fee is not refundable.

Social Security No.

Drivers License No.

Pets (Special written permission required)

Childrens Names and Ages

2. LAST THREE RESIDENCES

Landlords Name, Address, Phone No.

Previous Address, City and State

Address and Phone No.

Address and Phone No.

5. LIST OF MOTOR VEHICLES

Do You Desire Garage Rental?

License No. and State

6. LIST OF YOUR PROPERTY

WHICH WILL BE LOCATED ON THE RENTAL PREMISES

TVs, Stereos, Radios, etc.

8. CURRENT LOANS AND OBLIGATIONS

10. PERSONAL REFERENCES

In Case of Emergency, Notify:

13. RENTAL INFORMATION

How Did You Hear About This Rental Unit?

Saw Rental Unit While Driving By

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